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(January 21, 2026): The past year has been rough for many dental practices around the country. After declining during COVID, government and private payor audits of dental claims rose sharply in 2024 and continued to increase in 2025. The question we are now being asked by our dental clients is whether these activities will continue […]
Dental Claim Audits and Investigations are Expected to Increase in 2026 Read More »
(January 13, 2026): As the great Yogi Berra once said, “It’s tough to make predictions – especially about the future.” This maxim is especially true when it comes to forecasting the specific dental claim risk issues that will be the focus of private payor Special Investigation Units (SIUs) in 2026. Nevertheless, we are going to
Delta Dental Audits Will Increase in 2026. Is Your Practice Ready? Read More »
(February 22, 2022): The treatment and business challenges presented by COVID-19 over the last two years have been especially demanding on dentists and their practices. Between the lockdowns and a hesitancy by many individuals to schedule non-emergent dental care, many dental practices have found it tougher than ever to maintain previous levels of profitability. Not
A Review of Dental Enforcement in 2021 and a Look at What Dentists Should Expect in 2022 Read More »
(September 15, 2020): There are approximately 1.4 million active duty service members in our country. These active duty service members have approximately 1.9 million dependents. Our military also consists of almost a million reserve and national guard participants. Depending on an individual’s status, these active duty service members, their dependents, and reservists are likely eligible
United Concordia Dental and its SIU are Actively Auditing Dentists Around the Country. Read More »
(March 4, 2020): Many dentists and dental practices around the country are glad that 2019 is behind us. Last year was a banner year for law enforcement investigators and administrative auditors of dental claims. Federal and State prosecutors around the country actively pursued both civil and criminal cases against individual dentists for a variety of
(October 16, 2019): A Federal District Court Judge recently sentenced a Murfreesboro, TN dentist to prison and ordered that he pay restitution to TennCare (Tennessee’s Medicaid program). Regrettably, the types of improper billing practices cited by the government in the criminal Information filed against the defendant dentist aren’t that uncommon. This recent prosecution serves as
(August 17, 2019): Over the last year, we have seen a significant increase in the number of Medicaid and private insurance audits of dental claims. A common trigger for these audits included instances in which a practice improperly billed for the services of a non-credentialed dentist while using the identification number of a credentialed provider.
(January 3, 2019): Slowly but surely, the percentage of adults and children with dental insurance coverage benefits has gradually climbed. These increases have been driven, at least in part, by several factors. First, despite the fact that traditional Medicare does not cover routine dental services, a number of Medicare Advantage plans are now offering coverage
(December 7, 2018): Each state sets their own licensure requirements, rules and regulations regarding the practice of dentistry, all of which are subject to change. While there are differences from state to state, the approach taken by most states with respect to the practice of dentistry is fairly consistent. After conducting a review of several
Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered Read More »
(July 3, 2018): While a number of Medicare Advantage Plans now offer supplemental coverage for preventive, basic, and major dental services, only a narrow category of dental services qualify for coverage and payment under standard Medicare Part A (pursuant to Section 1862(a)(12) of the Social Security Act). Presently, only qualifying Medicaid beneficiaries are likely to
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